Pancreatic Apoplexy: Fulminant Necrotizing Pancreatitis Leading to Completion Pancreatectomy Within 3 Days After Partial Pancreaticoduodenectomy.

Autor:	Mintziras I; From the Departments of General and Visceral Surgery., Stollenwerk L; From the Departments of General and Visceral Surgery., Uhl W; From the Departments of General and Visceral Surgery., Niescery J; Anesthesiology, St Josef Hospital, Ruhr University Bochum., Belyaev O; From the Departments of General and Visceral Surgery., Luu AM; From the Departments of General and Visceral Surgery., Munding J; Institute of Pathology, Ruhr University Bochum, Bochum, Germany., Tannapfel A; Institute of Pathology, Ruhr University Bochum, Bochum, Germany., Künzli B; Department of Visceral Surgery, Kantonsspital Graubünden, Chur, Switzerland., Herzog T; From the Departments of General and Visceral Surgery.
Jazyk:	angličtina
Zdroj:	Pancreas [Pancreas] 2022 Oct 01; Vol. 51 (9), pp. 1128-1132.
DOI:	10.1097/MPA.0000000000002149
Abstrakt:	Objectives: Patient characteristics with postoperative acute necrotizing pancreatitis and completion pancreatectomy (CP) after pancreaticoduodenectomy (PD) remain unclear. Methods: Data from all patients who underwent a PD with need for CP (January 2011-December 2019) at a German University Hospital were analyzed regarding the indications and timing of CP, laboratory and histopathological findings, and overall outcome. Results: Six hundred twelve patients underwent PD, 33 (5.4%) of them needed a CP. Indications were grade C pancreatic fistula with or without biliary leak (46% and 12%), biliary leak (6%), and hemorrhage due to pancreatic fistula (36%). Eight patients (24%) underwent CP within 3 days after PD. These fulminant courses ("pancreatic apoplexy") were accompanied by significantly higher levels of lactate dehydrogenase, C-reactive protein, serum amylase, serum lipase, drain amylase, and drain lipase compared with patients with CP after the third day. Pancreatic apoplexy was histologically associated with higher rates of pancreatic necrosis (P = 0.044) and hemorrhage (P = 0.001). A trend toward higher mortality was observed (75% vs 36%, P = 0.058). Conclusions: Pancreatic apoplexy, defined as fulminant necrotizing pancreatitis after PD leading to CP within 3 days, is associated with characteristic laboratory and histopathological findings and a trend to higher mortality. Competing Interests: The authors declare no conflict of interest. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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